Socio-demographic factors associated with asymptomatic bacteriuria in children with sickle cell anemia in a tertiary health facility in South eastern, Nigeria

p. 137

BF Chukwu, HU Okafor, AN Ikefuna

Background: Urinary tract infection (UTI) is a common cause of chronic kidney disease in children. It is second only to respiratory tract infection in developed countries as a cause of morbidity and mortality arising from microbial infections. It is also common in a developing country like Nigeria and is the commonest cause of renal disorders in Port Harcourt, South South, Nigeria. UTI can be symptomatic or asymptomatic (asymptomatic bacteriuria). Asymptomatic bacteriuria is said to be more common in school aged girls and children of low socio-economic class. It has also been documented to be more common in children with sickle cell anaemia.
Objectives:To determine the relationship between asymptomatic bacteriuria and age, sex and socio-economic status of children with sickle cell anaemia.
Methods: One hundred children with sickle cell anaemia in stable state were screened for asymptomatic bacteriuria using midstream urine samples. The age, sex and social class of the children were obtained through a structured questionnaire administered to the parents/care-givers. The relationship between age, sex and social class with asymptomatic bacteriuria in these children was analyzed using SPSS software.
Results: The age of the children ranged from 2-12 years. Six of the 100 children were noted to have asymptomatic bacteriuria and five of the six children were females (p=0.04).Five (83.3%) of the six children were five years and above. There was a predominance of positive cases (66.7%) in the higher socioeconomic class (p=0.03).
Conclusion: Asymptomatic bacteriuria is commoner in school aged female sickle cell anaemia children of higher socioeconomic class. However, we suggest that further studies be done to confirm this finding especially with regards to the socioeconomic status of these children.

Detection of extended spectrum beta-lactamases in gram negative bacilli from clinical specimens in a teaching hospital in South eastern Nigeria

p. 141

CN Akujobi, Chika P Ewuru

Antimicrobial drug resistance seen among many gram-negative bacteria, especially those expressing the extended-spectrum β- lactamase (ESBL) enzymes that hydrolyze the expanded- spectrum cephalosporins has been on the increase. This has compromised treatment options and thus a threat to the containment of bacterial infections.
To determine the existence of the extended-spectrum β-lactamase enzymes in Nnewi, 250 clinical isolates of members of the family Enterobacteriaceae and Pseudomonas species from Nnamdi Azikiwe University Teaching Hospital, Nnewi were identified by conventional methods. These include Klebsiella species (96), E. coli (90), Pseudomonas species (37), Enterobacter species (13), Proteus species (6), Citrobacter species (5) and Salmonella species (3).
Antimicrobial drug susceptibility testing was carried out on all the isolates by the disc diffusion method. Extended Spectrum Beta- lactamases were detected by the double disc synergy test.
High level of antimicrobial resistance was noted in test organisms against some of the antimicrobial drugs: Ampicillin + Cloxacillin (93.2%), Tetracycline (90.8%), Streptomycin (82.4%), and Nalidixic acid (62%), and low level of resistance was observed against Ofloxacin (26.4%), Cefotaxime (28.8%) and Nitrofurantoin (28.8%). One hundred and forty four isolates (57.6%) were suspected ESBL-producers judged by their resistance to any of the third generation cephalosporins used but 40 (16%) actually produced the extended spectrum beta- lactamase enzymes.
This shows the existence of Extended Spectrum Beta- Lactamase producing gram negative organisms in Nnewi. Considering the treatment difficulties, as well as the high cost of treatment associated with these organisms, concerted efforts are needed to contain their spread.

Trends in maternal mortality at University of Maiduguri teaching hospital, Maiduguri, Nigeria - A five year review

p. 147

BM Audu, UI Takai, M Bukar

Background: Maternal mortality is on the rise in Nigeria with the North- East having the highest ratio, and Borno state records one of the highest maternal mortality ratios in the country.
Objective: To determine the trends in maternal mortality in UMTH, identify the background socio- cultural factors, establish the major causes of deaths and determine avoidable factors.
Study design: Retrospective study of maternal deaths.
Methods: The case records of all recorded cases of maternal deaths between January 2001 and December 2005 inclusive were retrieved and relevant data obtained and analysed.
Results: The maternal mortality ratio (MMR) for the period under review was 430 per 100,000 live births. There were annual fluctuations in MMR. However, there was a consistently rising trend in MMR from 2002-2004 with the highest ratio of 545 per 100,000 live births recorded in the year 2004, with a decline in 2005. Thirty (78.9%) of these deaths occurred among the unbooked patients and more than 90% of this were referred as obstetric emergencies. Age range was 14-39 years with a mean of 26.5years. The highest maternal death occurred at the two extremes of reproductive age group (14-19 years and 35 years and above). Grandmultiparas suffered the highest maternal mortality of 36.8%, followed by teenage mothers. P1-4 contributed the least to maternal mortality. The direct causes of maternal death accounted for 92.1% of the deaths. The major causes of death were eclampsia 34.2%, sepsis 26.3% and prolonged obstructed labour/ruptured uterus 13.2%. Amongst the indirect causes of maternal death, HIV/Tuberculosis was the leading cause accounting for 5.3%. Basic but professional antenatal care, skilled attendance at birth, community mobilization and health education messages for a healthy pregnancy and safe birth will help to reduce the unacceptably high maternal mortality ratio in Borno state and the country at large.

Background and Objective: Hepatitis B virus (HBV) infection is endemic in many regions of the world including Africa, Asia and Western Pacific [1],[2] . In Southeast Nigeria information on the seroprevalence of HBV infection among pregnant women is limited. This study was carried out to determine the seroprevalence of HBsAg among pregnant women attending antenatal care at an Onitsha specialist (private) hospital Anambra state, Southeast Nigeria.
Method: HBsAg was tested for in consenting women who attended antenatal care at Grace Specialist hospital Nkpor, Onitsha. The study women were recruited longitudinally from the hours of 8.00am to 12noon on each antenatal care day which held twice a week.
Results: The seropositivity of HbsAg in the pregnant women was 2.2%. There was no significant association between the HBsAg screening result and age or parity.
Conclusion: The seroprevalence of HBsAg in the pregnant women was 2.2% irrespective of their age, parity, or sociodemographic or biological factors. There is intermediate endemicity of HBsAg among pregnant women in Onitsha, Southeast Nigeria.

Ectopic pregnancy: A 5 year review of cases at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi

p. 160

GO Udigwe, OS Umeononihu, II Mbachu

Background: Ruptured ectopic pregnancy continues to be a common life threatening emergency in our environment as well as a public health problem.
Objective:This is to study the incidence, clinical presentation, risk factors and the management of cases that presented in our centre over a five year period.
Methods:This is a retrospective study of cases of ectopic gestations managed in the gynaecological unit of NAUTH Nnewi from January 1 st , 2002 to December 31 st , 2006. Information was obtained from the case notes, theatre and labour ward registers.
Results: During the period, a total of 2,746 deliveries were recorded while 556 gynaecological patients were admitted. Thirty six patients had ectopic gestations accounting for 1.3% of all deliveries and 6.5% of all gynaecological admissions. The peak age group was 26-30 years (44.4%); 28(77.7%) were married and 20 (55.6%) attained secondary school as their highest level of education. All 36(100%) of the patients were symptomatic at presentation. Abdominal pain, amenorrhoea and syncopal attack were the most common symptoms at presentation. Also, multiple sexual partners 27(75%), previous abortions 25(69.4%) and previous sexually transmitted infections 10(27.8%) were the most common risk factors present in the patients. Abdominal paracentesis 32(88.9%), ultrasound 8(22.2%) and urine pregnancy tests 7(19.4%) were most commonly utilized for diagnosis. None of the cases was diagnosed before rupture. Open abdominal surgery was the treatment employed in all the patients.
Conclusion:Ectopic pregnancy is still a major challenge in gynaecological practice in our centre. Most cases present late making tubal conservation treatment inapplicable. This has far reaching implications in a society where there is high premium on child bearing.

Glycaemic control amongst persons with diabetes mellitus in Benin City

p. 164

BC Unadike, A Eregie, AE Ohwovoriole

Objective: This study set out to find the level of glycaemic control amongst persons with diabetes mellitus in Benin City.
Methods: Forty two persons with diabetes had their glycaemic control assessed by measuring the level of their glycated hae­moglobin. Other data collected included age, sex, duration of diabetes, type of diabetes, weight, height, body mass index and waist hip ratio.
Results: There were twenty four males and eighteen females in the study population. Thirty one subjects had type 2 diabetes, while eleven had type 1 diabetes. Nineteen subjects (46%), had poor glycaemic control (HbAic > 7%) while twenty three (54%) had good control (HbAic ͳ 7%). Thirteen males (54%) had good control while ten females (53%) had good control and this was not statistically significant (p>0.05). Eighteen of the thirty-one type 2 DM subjects (58%) had good glycaemic control, while five persons out of eleven with type 1 DM (45%) had good glycaemic control and this was not statistically significant (p>0.05).
Conclusion: This study has shown that poor glycaemic control is common amongst persons with diabetes mellitus in Benin City. Studies have shown that good glycaemic control prevents and delays the complications of diabetes mellitus. We therefore recommend that health education on the benefits of good glycaemic control should be given in diabetes clinics, and ef­forts intensified to achieve target glycated haemoglobin levels to prevent diabetes complications.

Is the trend of amputation in Nigeria changing? A review of 51 consecutives cases seen at Federal medical centre Ebute Metta, Lagos, Nigeria

p. 167

AA Dada, BO Awoyomi

Introduction: Many previous studies from Nigeria have recognized trauma and complications of management of musculo-skeletal conditions by traditional bone setters (TBS) as the leading cause of amputation in Nigeria. However, of recent, a number of the studies are showing that diabetes gangrene which used to be an uncommon indication is becoming an important cause of extremity amputations. In view of the effect of amputation on the individual and the society and the success of well designed preventive programs, it is important that the indications for amputation be kept in constant view. The objective of this study is to draw attention to the increasing importance of diabetes gangrene as a leading cause of amputation in Nigeria.
Patient and Methods: This is a three-year prospective study (October 2006 - September 2009) using observer- administered questionnaires after consents were obtained from all patients or proxy during the period of study. All recruited patients were followed up and evaluated after surgery to determine the outcome. The following data were obtained and analyzed - age, sex, amputation type, indication and use of prosthesis.
Results: Fifty-one amputations were performed in fifty patients (37 males and 13 females). M.F = 2.8:1, age range 5 - 85 years, mean 47.6+/- S.D 20.7. Major limb amputations accounted for 35 cases (68.6 %) with diabetes gangrene accounting for 23 cases (45%) followed by Trauma accounting for 16 cases (31%). Wound infection was the commonest complication occurring in 16 cases (31.4%), Escherichia coli being the commonest causative organism. Only 6 patients (12%) eventually used prosthesis and the mortality in this series was 8 patients (16%).
Conclusion: Diabetic gangrene is the leading cause of amputation in this series. This is the first study in this environment to the best of the authors' knowledge where diabetes gangrene will emerge the leading indication. A number of other reports from Nigeria in the last few years have shown the progressive importance this condition is assuming as a leading cause of amputation. [1],[3] This finding therefore calls for more studies in this area and a more proactive approach by caring physicians to limb lesions by their Diabetic patients.

Background: Twin pregnancy continues to be a focus of interest the world over due to its increasing incidence and also the high maternal and perinatal mortality and morbidity associated with it.
Objective: To determine the incidence and mode of delivery of twin pregnancies at the University of Uyo Teaching Hospital, Uyo.
Methodology: A 5-year retrospective review of twin deliveries at the University of Uyo Teaching Hospital.
Results: There were 6,344 deliveries out of which 164 were twin deliveries resulting in an incidence of 2.6%. The modal age group of the patients was 20-29 years (66.5%), majority (71.3%) of the patients were multiparous, 79.3% booked and had regular antenatal care in the hospital while 49.4% of the patients delivered at term. Eighty-four patients (51.2%) were delivered by caesarean section and malpresentation of the first twin (18.2%) and hypertensive disorders of pregnancy (10.4%) were the most common indications. The perinatal mortality rate was 207/1000 and there was one maternal death which was from eclampsia.
Conclusion: The incidence of twin pregnancy and its attendant perinatal mortality is high in our center. In addition, caesarean section is the most common mode of delivery with malpresentation of the first twin and hypertensive disorders of pregnancy as the most common indications. We advocate widespread public enlightenment on the increased risk associated with twin pregnancy. Community leaders should ensure that women with twin pregnancy should book early and obtain antenatal care in specialized units.

Background: Hepatitis C virus is a chronic lifelong infection in the majority of patients who are infected with the virus. Not much is known and written/published about this virus in Nigeria.
Objective: To assess the status of hepatitis C virus infection in Nigeria.
Materials and method:Sources of information were mainly from published works in and outside Nigeria. The information was extracted over a period of 12 months from January to December 2009.
Results: So far the prevalence of hepatitis C. virus infection is increasing in Nigeria, ranging from 4.7-5% in Ilorin, to 5.3-6.6% in Enugu, to 11% in Ibadan and 20% in Benin. Children and adults are all at risk of being infected especially sickle cell disease patients. Others include those who are exposed to the common risk factors like Blood transfusion, haemodialyisis, recycling of syringes and needles, sexual promiscuity.
Conclusion: Reduction in the Hepatitis C virus infection could be achieved by Health education campaign of the general public and by support from government and non-governmental organizations for the to provision of antiviral and immunostimulatory drugs free of charge for those already infected.

Neurosurgery in Nigeria II - Evaluation of the perceptions of health personnel after the commencement of services in a new centre

p. 177

Jude Kennedy C Emejulu

Background: Prior to the commencement of neurosurgical services in our new centre, in 2006, the awareness of and perceptions about this specialty amongst the health workers were studied. One year after, having experienced first-hand the activities of the unit, these perceptions were again re-evaluated amongst the same workers to determine the impact of the unit on the opinions about the specialty.
Methods and Materials: This study was carried out with a questionnaire designed with the 5-point Likert scale, and the respondents comprised of doctors, nurses, students, paramedics and administrators, randomly selected. The same questionnaire was used in the first study but was slightly modified for the present study.
Results: Out of 400 questionnaires distributed randomly, 342 were completed and returned. Most of the respondents 282 (82.5%) were aged 20 - 30years, mostly students 220 (64.3%), and majority 318 (93%) have heard of neurosurgery prior to the establishment of our unit. The service need was rated very necessary by most 286(83.6%), availability of services in Nigeria rated inadequate by 177 (51.8%), and the quality of services rated fair 155(45.3%). The services in our centre were rated fair 138 (40.4%) and lack of equipment/facilities was adjudged the greatest hindrance to practice 216 (63.2%), and majority 289 (84.5%) strongly recommended that services continue.
Conclusion: Neurosurgical services are still significantly inadequate in Nigeria, and though the establishment of new units has positively changed the perception of health workers about the specialty, provision of more manpower and modern facilities remains the major challenge.

Experience with the rigid cysto-urethroscope: A multicentre review in Anambra State, South-East Nigeria

p. 180

CK Oranusi, A. M. E. Nwofor, EA Obiesie

Background: Cysto-urethroscopy or cystoscopy is an important tool for the practicing urologist for both therapeutic and diagnostic purposes. The indications for cystoscopy vary widely from centre to centre. We describe our experience with this tool.
Materials and Methods: We reviewed retrospectively the medical records of patients who had rigid cystoscopy at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Symbol specialist hospital, Nnewi and Borromeo specialist hospital Onitsha, all in Anambra State, Southeast Nigeria in the period January 2004 to December 2009. All indications were as reported in the initial diagnosis for all the patients.
Results: A total of one hundred and eleven patients had cystoscopy during the study period. Most of the patients who had cystoscopy were in the seventh48 (43.3%) and fifth26 (23.4%) decades of life. The male to female ratio was 2:1. The commonest indication for cystoscopy was for investigation of bladder tumors in 50(45.0%) of the patients. Other indications were for the investigation of hematuria in 31(28.0%) patients, hydronephrosis in 13(11.8%), urethral stricture 9(8.1%), cystitis 2(1.8%), bladder calculi 3(2.7%), prostatitis 1(0.9%), bladder fistula 1(0.9%), and urinary incontinence 1(0.9%).
Conclusion: The indications for Cystoscopy vary from centre to centre. In our experience, the most common indication is for bladder tumors. The procedure is well tolerated by patients with a low incidence of morbidity. Studies have shown that the flexible cystoscope offers more advantage in that it is less invasive and can be done under local anaesthesia.

Objective: We have seen many black African women with uterine fibroids. We have also seen many with just epileptic attacks only. This is the first female, to our knowledge, to present with both afflictions; the convulsions stopping after the myomectomy. Hence, this report.
Materials and Method: This 30-year old single nulliparous black Nigerian female was first seen in August 2002 in our outpatient's department. She had complained of having frequent generalized convulsions since 1988. Native medications had been of no help. Clinical examination revealed no gross neurological deficit, but a large uterine fibroid. With the diagnosis also of grand mal epilepsy, she was placed on epanutin and phenobarbitone, which prolonged the intervals of the attacks. She eventually asked for the removal of the fibroid, which was done on the 1 st of March, 2006. She was discharged home 7 days later, when the stitches were removed, and to continue the same anti-epileptic drugs, as mentioned earlier. She was to return for follow-up checks 7 days after discharge from hospital.
Result: The patient tolerated the myomectomy very well. The histopathology of the specimen was that of a leiomyoma with degenerative changes. The attacks reduced greatly in severity, with prolonged intervals, 3 months after surgery. We have not seen her again, but reports reaching us suggest that she is alive, well and free of convulsions.
Conclusion: This is an unusual case of a huge uterine leiomyoma in an epileptic female or vise versa. The removal of the tumor appeared to have controlled the seizures.

Spontaneous rupture of gravid horn of bicornuate uterus at term - A case report

p. 184

Betrand O Nwosu, Joseph O Ugboaja, Amaka Obi-Nwosu

Uterine structural abnormalities are known causes of recurrent pregnancy losses occurring especially within the second trimester. However, recent reports show that the rate of pregnancy losses caused by uterine anomalies may not be as high as previously feared. We report a case of a 28 year old secondigravida with uterus bicornis unicollis who had spontaneous rupture of one of the uteri in pregnancy, had excision of one horn of the double uterus and was able to carry a subsequent pregnancy to term and achieve a live birth. The literature on double uterus was also reviewed.